Malignant Health Diplomacy: The Global Gag Rule and Gendered Impacts of COVID

• In Event: International Political Economy Virtual Poster Session

Abstract

How do international policies interact with local dynamics in the management of global health crises, and how do the consequences impact women? Research on the COVID-19 pandemic highlights that women face differential health, economic, and social impacts from global health emergencies such as increases in gender-based violence (Cousins, 2020), gendered burdens of unpaid care work (Power, 2020), frontline work (McLaren et al., 2020), and decreases in paid work hours (Collins et al., 2020) and access to health services (Hall et al., 2020). Indeed, the UN warns that the gendered implications of the pandemic may create significant setbacks towards fulfilling the sustainable development goals (Azcona et al., 2020). Scholars and the WHO alike have identified priority areas for governments to address these inequalities: increase resources for domestic violence, provide access to sexual and reproductive health services, and ensure women’s economic livelihood (Wehnam et al, 2020; WHO, 2020). While scholars and organizations rightfully discuss many systemic, domestic barriers facing women, absent from research to date are the international determinants of the gendered impacts of COVID-19.
This paper argues that in order to understand the full impact of COVID-19 on women in low- and middle-income countries, it is imperative that we examine the role of health diplomacy. Based on 54 interviews with sexual and reproductive health and rights stakeholders and healthcare providers in in Kenya, this paper shows that the US’s Global Gag Rule has had a dramatic impact on women’s health by hampering the NGOs’ ability to respond to an influx of needs induced by COVID-19.
Health diplomacy occurs when states center health in some aspect of foreign policy. From foreign aid for health initiatives, to WHO contributions, to mass vaccination programs, to US’s PEPFAR program to fight HIV, numerous examples exist of governments engaging in health diplomacy. Although this practice is not new, the emergence of COVID-19 provides more opportunities for political scientists to focus their scholarship on this field. The definition of health diplomacy is not limited to foreign aid or cooperation given merely to promote health. Countries also engage in health diplomacy when they give foreign aid or lend cooperation to health programming meant to promote foreign aims that are non-health related (Fazal, 2020). In other words, health diplomacy can be used to promote health or as a means for one country to promote their foreign aims through health programs.
Not all forms of health diplomacy are innocuous. States, while pursuing their own domestic agenda, can employ health diplomacy that undermines public health in other countries. The US’s Global Gag Rule, most recently implemented in 2017, is one such example. In pursuing a global anti-choice agenda consistent with its domestic anti-choice policy, the US reduced foreign aid to sexual and reproductive health NGOs in low- and middle-income countries. Due to the Global Gag Rule, these NGOs were already underfunded when confronted with unprecedented challenges arising from the COVID-19 pandemic.
This paper draws on data collected during spring and summer 2020 from 54 interviews with NGO leaders and healthcare providers in Kenya. Participants revealed four major ways in which the interaction of the Global Gag Rule with the COVID-19 crisis was affecting their organizations’ ability to provide for the needs of Kenyan women: 1. Demand-side factors (including a greater demand for services due to increases in both gender-based violence and teen pregnancy); 2. Supply-side factors (such as a decrease in the number of clinics and clinicians available to provide these necessary services); 3. Barriers to service access (including difficulty obtaining preferred contraceptives); and 4. Spillover effects (such as difficulty obtaining HIV resources like antiretrovirals and counseling services).
These findings have implications for both health diplomacy research and investigations into the gendered impacts of global health emergencies such as COVID-19. They also highlight that the emerging field of health diplomacy, so far largely focused on the positive impacts, should include a focus on the potentially adverse consequences of this type of foreign policy. Moreover, this paper showcases the need to consider international politics in order to accurately assess the mechanisms underlying the gendered effects of health emergencies. In order to understand the differential impacts of health crises on women, we must incorporate all levels of analysis.

Author

• Kelly Hunter